In North Carolina, an Obamacare disconnect

RALEIGH, N.C. — North Carolinians came out in droves for Obamacare enrollment, signing up at a rate that beat nearly every other red state. But that doesn’t mean they’re going to come out for the law — or the Democratic senator who supported it — at the voting booth in November.

More than any other state, North Carolina may represent the huge disconnect between Obamacare’s success in getting people health insurance and its failure to help the Democratic politicians who voted for the law.

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The Tar Heel State signed up more than 357,000 people — one-third of those eligible for the new health insurance exchange. Yet President Barack Obama’s health law remains a major liability for Sen. Kay Hagan, who faces one of the toughest reelection races for any Senate Democrat this year, a true toss-up fight against North Carolina House Speaker Thom Tillis. He misses no chance to tie her to Obama and the Affordable Care Act, forcing her to calibrate both how to defend a law she voted for and how to distance herself from it.

The North Carolina dynamic reflects a national problem for the Obama administration in this midterm election: Despite the solid numbers — 8 million enrolled in Affordable Care Act plans, and 6.7 million signed up for Medicaid — they just can’t move the dial on political support for Obamacare.

The state had the third-highest rate of enrollment among states that decided not to set up their own exchange — only Florida and Maine came out ahead of it.

White House allies mobilized against Republican state leaders who had obstructed the law, organizing volunteers, outreach staff and local advocates to help people sign up. The administration sent more than $3 million to fund enrollment assistance workers known as navigators — more money than it sent to most other states. Clinics and health facilities also worked hard to get their uninsured patients covered. The numbers were strong, even though the Republican state leaders would not expand Medicaid, which could have covered up to a half-million more — a decision that Hagan criticizes.

Many people who enrolled in North Carolina and elsewhere in the country report mixed feelings about their new Obamacare health plans or the costs. The individual mandate, and the threat of a penalty, drove many sign-ups. A polling report by PerryUndem, an opinion research firm that specializes in health care, found that 40 percent of people in one focus group say they might not have signed up without the mandate. But neither an unpopular mandate nor worries about the expense are a political advantage.

One major reason that enrollment is not translating to a political boost — at least not yet — is that the groups that worked to sign people up, such as Enroll America, made a decision to keep insurance coverage as far from politics and “Obamacare” as possible. They kept the conversation focused on the value of health insurance, the ban on denials for pre-existing conditions and the tax subsidies available to make coverage more affordable.

While that helped the administration reach the pivotal 8 million point, many of the newly covered don’t associate their own insurance status with Obamacare — or at least not the political debate around the law, a phenomenon that Mike Perry, a partner at PerryUndem, called a “split personality.”

“You see the disconnect of the personal benefit to them and changing their thinking around the law,” he said of the focus groups he’s done with Obamacare enrollees. They view the two issues on different planes. The insurance, he said, “is a personal thing. It is personally benefiting them and it has nothing to do with the law that they don’t understand.”

That disconnect is haunting Hagan, who doesn’t go out of the way to tout her vote for Obamacare — what Tillis calls “Kay Hagan’s Obamacare Dodge.” She often keeps her comments focused on a piece of it, the failure of state Republicans, including Tillis, to expand Medicaid. Her campaign website doesn’t feature Obamacare, except for provisions that affect women’s health, and even there she doesn’t link them clearly to the president’s health law.

Hagan was not available for an interview during a reporter’s recent visit here. Her campaign spokeswoman downplayed the controversy over Obamacare, and stressed its more popular benefits.

“This is one of many issues in this election,” spokeswoman Sadie Weiner said. “Like all the issues, it is a strong contrast between Kay’s work to make common-sense fixes to the health care law to make it work better, and Tillis, who brags about rejecting health care for 500,000 people and who would take us back to a time when women were charged more than men, seniors paid more for prescriptions and people could be denied care because of a pre-existing condition.”

The law’s trade-offs even weigh on its supporters, like Jeremy Reynolds. He volunteered with Enroll America, standing outside grocery stores and Kmarts to encourage people to get covered, and even signed up for his own subsidized policy. But when he used his new coverage to get treatment for a pinched nerve he found it a “hassle.”